What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic mitral regurgitation (n=87). Intervention: Restrictive mitral annuloplasty. Primary outcome: Reverse remodeling (defined as a 10% reduction in left ventricular dimension).

What question did this study set out to answer?

To assess the extent of left ventricular reverse remodeling and identify clinical and anatomical predictors following restrictive mitral annuloplasty for ischemic mitral regurgitation.

February 3, 2005European Journal of Cardio-Thoracic SurgeryOpen Access

Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation☆

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Key result

Restrictive mitral annuloplasty significantly reduced left ventricular end-diastolic dimension from 64 to 58 mm (P<0.01), with preoperative dimensions ≤65mm strongly predicting reverse remodeling.

Why the study?

Does restrictive mitral annuloplasty induce reverse remodeling in patients with ischemic mitral regurgitation?

Key Points

To assess the extent of left ventricular reverse remodeling and identify clinical and anatomical predictors following restrictive mitral annuloplasty for ischemic mitral regurgitation.
Evaluated 87 consecutive patients with ischemic mitral regurgitation and a mean baseline ejection fraction of 32±10% undergoing restrictive mitral annuloplasty, with 75 patients receiving concurrent coronary revascularization.
Performed transthoracic echocardiography at 18 months postoperatively to assess residual mitral regurgitation, transvalvular gradient, and left ventricular dimensions.
Defined reverse remodeling as a ≥10% reduction in left ventricular dimensions and identified cut-off values using univariate, multivariate, and receiver-operating characteristic (ROC) analyses.
At 18 months, mitral regurgitation grade decreased from 3.1±0.5 to 0.6±0.6, left ventricular end-systolic dimension decreased from 52±8 to 44±11 mm (P<0.01), and end-diastolic dimension decreased from 64±8 to 58±10 mm (P<0.01).
NYHA functional class improved from 3.0±0.9 preoperatively to 1.3±0.5 at 29 months follow-up (P<0.01), with early and late mortality rates of 8.0% and 7.5%, respectively.
Preoperative left ventricular end-diastolic dimension was the strongest predictor of reverse remodeling, with optimal cut-off values of 65 mm for end-diastolic dimension (AUC 0.92, sensitivity/specificity 89%) and 51 mm for end-systolic dimension (AUC 0.85, sensitivity/specificity 81%).

Study Design

Type

Cohort (n=87)

Structured PICO

Does restrictive mitral annuloplasty induce reverse remodeling in patients with ischemic mitral regurgitation?

Population

87 consecutive patients with ischemic mitral regurgitation and a mean ejection fraction of 32+/-10%

Intervention

Restrictive mitral annuloplasty (downsizing by two ring sizes, median ring size 26), with additional coronary revascularization in 75 patients

Outcome

Reverse remodeling of the left ventricle (defined as a 10% reduction in left ventricular dimension) at 18 monthssurrogate

Restrictive mitral annuloplasty induces reverse remodeling in ischemic mitral regurgitation, but this effect is limited in patients with preoperative left ventricular end-diastolic dimensions exceeding 65 mm.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports patient selection by preoperative LVEDD ≤65 mm; leaves open randomized confirmation of clinical benefit in ischemic MR.

Cite This Study

Braun et al. (2005) conducted a cohort in Ischemic mitral regurgitation (n=87). Restrictive mitral annuloplasty was evaluated on Reverse remodeling (defined as a 10% reduction in left ventricular dimension). Restrictive mitral annuloplasty significantly reduced left ventricular end-diastolic dimension from 64 to 58 mm (P<0.01), with preoperative dimensions ≤65mm strongly predicting reverse remodeling.

synapsesocial.com/papers/6a090a6462c780efd627fd26 https://doi.org/10.1016/j.ejcts.2004.12.031

Topics

Mitral valve intervention

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Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation☆

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation☆

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider